Sleep Disorders Diagnosed?

Sleep Disorders Diagnosed?
Depending on what your symptoms are, your doctor will gather various kinds of information and consider several possible tests when trying to decide if you have a sleep disorder: Sleep history and sleep log. Your doctor will ask you how many hours you sleep each night, how often you waken during the night and for how long, how long it takes you to fall asleep, how well rested you feel upon awakening, and how sleepy you feel during the day. Your doctor may ask you to keep a sleep diary for a few weeks. Your doctor may also ask you if you have any symptoms of sleep apnea or restless legs syndrome, such as loud snoring, snorting or gasping, morning headaches, tingling or unpleasant sensations in the limbs that are relieved by moving them, and jerking of the limbs during sleep. Your sleeping partner may be asked if you have some of these symptoms, as you may not be aware of them yourself.

Sleep recording in a sleep lab (polysomnogram). A sleep recording refers to a polysomnogram (poly-SOM-no-gram) or PSG test that is usually done in a sleep center or sleep laboratory. You will likely stay overnight in the sleep center with electrodes and other monitors placed on your scalp, face, chest, limbs, and finger. While you sleep, these devices measure your brain activity, eye movements, muscle activity, heart rate and rhythm, blood pressure, and how much air moves in and out of your lungs. This test also checks the amount of oxygen in your blood. A PSG test is painless. In certain circumstances, the PSG can be done at home. A home monitor can be used to record heart rate, how air moves in and out of your lungs, the amount of oxygen in your blood, and your breathing effort.
Multiple Sleep Latency Test (MSLT). Particularly useful for diagnosing narcolepsy, this test measures how sleepy you are during the day. In this test, typically done after an overnight sleep recording (PSG), monitoring devices for sleep stage are placed on your scalp and face. You are asked to nap four or five times for 20 minutes every 2 hours during times in which you would normally be awake. Technicians note how quickly you fall asleep and how long it takes you to reach various stages of sleep, especially REM sleep, during your naps. Normal individuals either do not fall asleep during these short designated nap times or take a long time to fall asleep. People who fall asleep in less than 5 minutes are likely to require treatment for a sleep disorder, as are those who quickly develop REM sleep during their naps. It is important to have a sleep medicine specialist interpret the results of your sleep monitoring test (PSG) or MSLT. A number of factors can make a person susceptible to sleep apnea. These factors include:
- Throat muscles and tongue that relax more than normal while asleep
- Enlarged tonsils and adenoids
- Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open
- Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area
- Congestion, due to allergies, that can also narrow the airway
- Family history of sleep apnea
If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include:
- A medical history that includes asking you and your family questions about how you sleep and how you function during the day.
- Checking your mouth, nose, and throat for extra or large tissues—for example tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (roof of your mouth in the back of your throat).
- An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG).
- A Multiple Sleep Latency Test (MSLT), usually done in a sleep center, is used to see how quickly you fall asleep at times when you would normally be awake. Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea. Once all the tests are completed, the sleep medicine specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms:
  - Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep.
  - Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airway to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway.
  - Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms.
  These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous Positive Airway Pressure (CPAP) is the most effective treatment for sleep apnea in adults. CPAP delivers air into your airway through a specially designed nasal mask attached to a machine that acts as a pump. The mask does not breathe for you; the flow of air creates enough increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stomach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep medicine specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, the prescription drug modafinil may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea.
  
  Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist may also recommend this. A custom-fitted plastic mouthpiece will be made by a dentist or an orthodontist—a specialist in correcting teeth or jaw problems. The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. Some people who have sleep apnea, depending on the findings of the evaluation by the sleep medicine specialist, may benefit from surgery. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and part of the soft palate (roof of the mouth in the back of the throat). Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypassing the obstruction in the upper airway.